Speech Sound Disorder in Children and Adolescents

Speech sound disorder refers to any combination of difficulties with perception, motor production, and/or the phonological representation of speech sounds and speech segments that impact speech intelligibility. The disorder is characterized by:

• Persistent difficulty with speech sound production that interferes with speech intelligibility or prevents verbal communication of messages
• Limitations in effective communication that interfere with social participation, academic achievement, or occupational performance, individually or any combination.

Speech sound disorders can impact the form of speech sounds or the function of speech sounds within a language. Children with speech production difficulties may experience trouble with phonological knowledge of speech sounds or the ability to coordinate movements of the articulator (i.e, the jaw, tongue, and lips), with breathing and vocalizing for speech. A speech sound disorder is diagnosed when speech sound production is not what would be expected based on the child’s age and developmental stage and when the deficits are not a result of a physical, structural, neurological, or hearing impairment.

Signs and symptoms of speech sound disorders include:

• Omissions/deletions—certain sounds are omitted or deleted (e.g., "cu" for "cup")
• Substitutions—one or more sounds are substituted (e.g., "wabbit" for "rabbit")
• Additions—one or more extra sounds are added or inserted into a word (e.g., "buhlack" for "black")
• Distortions—sounds are altered or changed (e.g., a lateral "s")
• Whole-word/syllable-level errors—weak syllables are deleted (e.g., "tephone" for "telephone") or a syllable is repeated or deleted (e.g., "dada" for "dad")
• Prosody errors—errors occur in stress, intensity, rhythm, and intonation.

Not all sound substitutions and omissions are speech errors. Instead, they may be related to a feature of a speaker's dialect or accent. Any regional, social or cultural/ethnic variations should be taken into account before considering a diagnosis.

A number of studies have identified risk factors associated with speech sound disorders in children. These risk factors include male sex, oral sucking habits, ear, nose and throat problems, family history of speech and language problems, low facial muscle tone, inability to coordinate facial musculature, and low parental education.

Children with speech sound disorder respond well to treatment, and speech difficulties improve over time. Thus, the disorder may not be lifelong for some children. However, when a language disorder is also present, the speech disorder has a poorer prognosis and may be associated with specific learning disorders.

Clinical research suggests the following treatments are indicated for the treatment of children and adolescents with speech sound disorder:

• Speech-Language Services: language intervention services facilitated by speech-language pathologists (SLPs) in a school environment that improve language, learning, and communication. The intervention is individualized to target the primary area of deficit (e.g., motoric articulation and/or phonological knowledge).
• Parent-Provided Therapy: parent facilitated speech-language therapy provided in the home. The services are conducted under the provision of a SLP. Research indicates that home-based services, in conjunction with school-based therapies, lead to greater progress towards speech and language goals over time.

In addition, research suggests the following interventions are promising:

• Naturalistic speech intelligibility treatment- treatment of targeted sounds in naturalistic activities (e.g., using a fast food menu)  
• Audiologist screening